A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage.

IF 2.5 4区医学 Q3 TOXICOLOGY

Journal of Medical Toxicology Pub Date : 2024-01-01 Epub Date: 2023-10-16 DOI:10.1007/s13181-023-00970-2

Damilola Idowu, Zachary Gray, Matthew Stanton, William Rushton, David Gummin

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引用次数: 0

Abstract

Introduction: For many years, the standard of care in the USA has been to treat acute lead encephalopathy with a combination parenteral dimercaprol (BAL) and CaNa₂EDTA. We present a case of a pediatric patient with severe lead encephalopathy, complicated by cardiac arrest, who was treated with an alternative regimen when CaNa₂EDTA was unavailable.

Case report: A 24-month-old male was brought by ambulance to an emergency department (ED) with new onset seizures and sustained a cardiac arrest. An initial blood lead concentration returned at 263 mcg/dl. The hospital was unable to obtain CaNa₂EDTA due to the nationwide shortage. For this reason, the patient was chelated with BAL IM for 12 days and dimercaptosuccinic acid (DMSA) for 28 days. He received a second 5-day course of BAL due to rebounding blood lead concentrations. Eight days after cardiac arrest, he was extubated; however, despite ongoing therapy, subsequent follow-up 2 months later demonstrated persistent cognitive deficits.

Discussion: The combination of DMSA and BAL was effective in rapidly decreasing whole blood lead concentrations. Drug shortages continue to have implications for the management of poisoned patients. This case highlights how shortages of chelating agents complicate patient care.

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一例严重铅中毒性脑病伴心脏骤停的病例。

简介：多年来，美国的护理标准一直是用肠外二巯基丙二醇（BAL）和CaNa2EDTA联合治疗急性铅脑病。我们报告了一例患有严重铅性脑病并伴有心脏骤停的儿童患者，当无法获得CaNa2EDTA时，他接受了替代方案的治疗。病例报告：一名24个月大的男性因新发癫痫发作并持续心脏骤停被救护车送往急诊室。血铅的初始浓度恢复为263微克/分升。由于全国范围内的短缺，医院无法获得CaNa2EDTA。因此，患者用BAL IM螯合12天，用二巯基丁二酸（DMSA）螯合28天。由于血铅浓度回升，他接受了第二个为期5天的BAL疗程。心脏骤停八天后，他被拔管；然而，尽管正在进行治疗，但2个月后的随访显示出持续的认知缺陷。讨论：二甲基亚砜和BAL联合应用能有效降低全血铅浓度。药品短缺继续对中毒患者的管理产生影响。这个案例突出了螯合剂的短缺如何使患者护理复杂化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Medical Toxicology TOXICOLOGY-

CiteScore

5.40

自引率

10.30%

发文量

期刊介绍： Journal of Medical Toxicology (JMT) is a peer-reviewed medical journal dedicated to advances in clinical toxicology, focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects resulting from medications, chemicals, occupational and environmental substances, and biological hazards. As the official journal of the American College of Medical Toxicology (ACMT), JMT is managed by an editorial board of clinicians as well as scientists and thus publishes research that is relevant to medical toxicologists, emergency physicians, critical care specialists, pediatricians, pre-hospital providers, occupational physicians, substance abuse experts, veterinary toxicologists, and policy makers. JMT articles generate considerable interest in the lay media, with 2016 JMT articles cited by various social media sites, the Boston Globe, and the Washington Post among others. For questions or comments about the journal, please contact jmtinfo@acmt.net. For questions or comments about the journal, please contact jmtinfo@acmt.net.